1. No category

. 2 1 9 2551
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ก 4707xxx
Chiangmai Medical School
Internal Medicine
1. =9>"%?&""3 32 A !$ %"$ +'1
=7
% ='ก2%B&ก& # Urine protein 1+,
red blood cell cast ก(2#&&00!(
specific 5%ก&2& "0=9 >""
ก
3!
1) Rheumatoid factor
2) ANA
3) Anti-histone antibody
4) Anti-dsDNA antibody
2. =9>"%?&"3 35 A 5$ !( +'1(&
4 ก( #"' 3(8!
(!57
'5 + #+#".215(2# wbc =
89000, PMN = 90%, G/S: gram negative diplococci
intracellular กกj0!(
%1
3!
1) Cloxacillin
2) Gentamicin
3) Ceftriazone
4) Doxycycline
5) Metronidazole
3. =9>"/""ก' /ก+ Generalized tonic clonic
B&-1&3& %3%ก0/#".!& =9>"("
ก/ก+
ก( (
2กก2(ก"
(# neurological deficit 0!$+(#(
papilledema ='
CT scan: multiple calcified cystic lesions /ก( 0
0!(
(2150%ก&!ก0/"=9
ก
3!
1) Taenia solium
2) Taenia saginata
3) Toxocara
4) Toxoplasma
5) Gnathostoma
4. =9>"/""3 55 A+%$ '!ก!"
5%ก'!' 4 ก& 'ก0 1 ! ='ก2 AFB !='
negative 3 &!(ก =' CXR #(
reticulonodular
infiltration with thickening cavity กB&0& 0!(
(21%1ก=9>""
ก
3!
1) =' culture for TB
2) Start anti-TB drug
3) Bronchoscopy
4) Aspiration
5) PCR for TB
5. =9>"/""3 18 A "
" *'
"!8ก 2
!%.ก( #"' (
ก(++
ก7"$ +#".5ก2(ก"#(
Upper
6.
7.
8.
9.
10.
motor power 4/5, lower 1/5, absent DTR 0!ก
&&2"0=9>""
%1
3!
1) Transverse myelitis
2) GBS
3) MG
4) Neurosyphilis
=9/""3 30 A %" 1 ! +#".5ก2(ก"
#(
neck vein engorgement, hepatomegaly tu!
ก& ='2กก2 EKG #(
diffuse ST-T change,
low voltage 0!ก&&2"0=9>""
%1
3!
1) Restrictive pericarditis 2) Cardiac beriberi
3) Cardiac tamponade
4) DCM
=9/""3 50 A ก&%' 5 !"!'&Ay
%' !
7 +#".5ก2(ก"#(
tenderness and guarding at epigastrium, liver dullness
+ve 0!ก&&2"0=9>""
%1
3!
1) acute pancreatitis
/""3 60 A 3(57ก'3(&:%'*70/"
!+ *(ก&!2ก 1
1) Cellulitis
2) Contact dermatitis
3) Dermatitis herpetiformis 4) Herpes simplex infection
5) Varicella zoster infection
=9>"%?&"3 40 A ก!6"+'1
+#".5ก2(ก"#(
BT = 39 °C, erythema
and tender at left upper thigh 21+'!% /ก( 00!(
(2150%ก&!ก0 =9>""
ก
3!
1) S. aureus
2) S. pyogenes
3) H. influenzae
4) P. aeruginosa
=9>"/"" 9"3 1& 125!& DM, HT
!"ก/+'1(+ 1 10 2ก%"ก& 0!ก&&2"0=9> ""
%1
3!
1) TIA
2) Temporal lobe ischemia
3) Cerebella ischemia
4) Bell}s palsy
11. =9>"/""3 18 Aก( %
3 ~#(ก"+8+!
(
125 ก Upper respiratory tract
infection =9>"!" % ='2กก2 CXR
#(
Interstitial infiltration "B&/
10!%1
3!0
=9>""
1) Ampicillin
2) Ciprofloxacin
3) Roxithromycin
4) Gentamicin
5) Augmentin
12. 0ก
%&"'"+%(%7 3(#
!0%3(0%ก&
5'(&:ก %'2ก =9>"
ก67 !
j1
+'1 '2
" 0!(
(2150%ก&!ก0
=9>""
ก
!3 (%'2ก59'2ก+('1*
ก+' #(
25'กก& 5 'ก)
1) Hypokalemia
2) Hyperkalemia
3) Hyponatremia
4) Hypernatremia
5) Hypocalcemia
5) Acute gastric dilation
6) SIADH
13. #&j
#0
50%ก&!ก peripheral
neuropathy (wrist drop) +'16
!1
14. =9>" CKD K = 7, EKG change 2กกกj
5?
3!0=9>""
15. =9>"/""3 40 A +'1!" 3 =9>"0%1&( '1+ก
5+'1=9>"'3"5 ก
2ก3ก +#".5ก2(ก"#(
BP =
120/80 mmHg, PR = 110 /min, RR = 24 /min, BT = 39 °C,
mild jaundice, lung clear, liver 2 cm BRCM 0!ก
&&2"0=9>""
%1
3!
1) Enteric fever
2) Dengue fever
3) Leptospirosis
4) Scrub typhus
5) Murine typhus
16. =9>"%?&"3 50 A !"ก!+ 7!
'5ก '3ก2กก
'5ก 4 !%.ก( #"'
+#".5ก2(ก"#(
tenderness of
quadriceps muscle, purple-red discoloration over the
upper forehead, eyelids and cheeks 0!ก&&2"
0=9>""
%1
3!
17.
18.
19.
20.
21.
1) Polymyositis 2) Dermatomyositis
3) Psoriasis
4) Mixed connective tissue disease
5) SLE
=9>"/""3 40 A ก+%$ 1 !ก(
#"' กกก% +'1"8 %1
(
'! 2(ก"ก& ='ก2
CXR #( WNL กB&&00!(
(21%1
ก=9>""
ก
3!
1) Skin test
2) CT chest
3) Sputum AFB
4) Bronchoscopy
5) PFT
=9>"/""3 50 A ก&%' 25 A ก
%" 1 !%.ก( #"' +#".5 ก
2(ก"#(
BP = 120/70 mmHg, fine crepitation
both lower lungs, PMI 6th ICS 1 cm lateral to MCL, S3
gallop กกj
%1
3!0=9>""
0!
1) Digoxin
2) Thiamine
3) Atropine
=9>"/"%'2กก'2ก5ก +'1+='!+!09
(+='3%
2
) /ก( 00!(
(2150%ก&!ก
0 =9>""
ก
3!
1) Chigger mite
2) Louse
3) Aedes egypti
4) Tick
5) Flea
=9>"/"" #"'!"ก/
&:
+#".5ก2(ก"#(
BP 60/30 mmHg (
sacral reflex 0!ก&&2"0=9>""
%1
3!
1) Cardiogenic shock
2) Spinal shock
3) Neurogenic shock
4) Hypovolemic shock
5) Obstructive shock
"3(/""3 18 A +8+!
ก% %"02'5ก
กก5'ก" +'1ก' ก 2-3 0
!
=( +#".5ก2(ก"#((
=&!ก&0!$ กกj
%1
3!0=9>""
0!
22.
23.
24.
25.
26.
27.
28.
1) inhale salbutamol prn + inhale corticosteroid
2) alpha-agonist as need
3) steroid '!
4) β2 agonist as need + steroid '!
5) Oral bronchodilator
6) Salbutamol inhalation as needed
7) Long acting β2 agonist + corticosteroid
8) Inhaled corticosteroid
=9%?& subacute thyroiditis 0%"0!#'!ก
1) ASA + propanolol
T4 ก& TSH ก& Dx?
1) Simple Goiter
2) Iodine deficiency
3) Thyroid CA
4) Subacute thyroiditis
5) Hashimoto thyroiditis
=9%?&"3 28 A (ก0("u1 2 (
(+ /*71!1! PE : DTR 3+ , loss of
sphincter tone =9>"
lesion "9(
%
1) Parasagital sinus
2) Basal pons
3) Thoracic area
4) Lumbosacral area
5) Conus medularis
EKG : bradycardia (2 vital sign #(=9>"
! '%&ก (80/50 mmHg, HR = 30) กกj
%1
3!0=9>""
0!
1) Atropine
2) Dobutamine
=9>"%?&"3 27 A 28 2 !%. PE: white patch
8+'1'& *(21(21#0%!%3=' !
3!
1) anti-HIV
=9>"/" 0% EKG ( ( Mobitz II) 210%"1
1) Atropine
2) Lidocaine
3) Digitalis
4) Cardioversion
=9>"%?&"3 68 A +#".5ก2(ก"3ก
"(ก&!
210%6
0!
1) Rabies vaccine
2) Tetanus vaccine
3) HBV vaccine
4) Influenza vaccine
5) HPV vaccine
29. =9>"%?&"3 18 A ก28%ก %
ก!
7 PE: lung clear, " rub chest &!(
1
1) Endocarditis
2) Pancarditis
3) Myocarditis
4) Pneumonia
30. =9>"/""3 16 A homozygous β-thal '!
125 ก(#'
"+'1 1 ! +#".5
ก2(ก" BP drop, irregular heart rate &
rhythm, hepatosplenomegaly *( =9>"
heart
complication 2ก1
1) Cardiac siderosis
2) Cardiac hypertrophy
3) Immune cardiomyositis
4) Extramedullary hematopoiesis at heart
31. Clinical rheumatoid arthritis "0!'!!83!
1) Ibuprofen
2) Paracetamol
3) MTX
4) Sulfazalazine
5) Chloroquine
32. =9>"9"3
125 DM with HT +#".5ก
2(ก" Costovertebral angle tenderness
กกj
%1
3!0=9>""
0!
1) Ceftriaxone IV
2) Ceftriaxone ก&
3) Ofloxacin ก&
33. /""3 22 A %!&0%5 (
2(ก"# PR
5 RR 5 miosis กกj
%1
3!0=9>""
0!
1) Atropine
2) Naloxone
3) Diazepam
34. =9>"%?& 40 A %ก 80 kg 9 160 cm. #& Dx. DM, FBG
180 กกj
%1
3!0=9>""
0!
1) 3%
2) Metformin
3) Acarbose
4) Glibenclamide
35. =9>"%?& 25 A 02 ก&23 .'! 1 A, PE: mild
exophthalmos, generalized enlarged thyroid both lobe,
†.(Graves}), T4..,T3 400, TSH < 0.001 กกj
%1
3!0=9>""
0!
36.
37.
38.
39.
40.
41.
1) Propanolol
2) Lugol solution
3) PTU
4) Radioactive iodine
5) Subtotal thyroidectomy
/" 32 A ก02 5 %ก'! BP 150/100 mmHg PR
120/min PE: neuro sensory normal, muscle weak gr. 1/5
both upper and lower, reflex 2+ all Lab: Na 136 mmol/l,
K 2.5 mmol/l, Cl 102 mmol/l, CO2 22 mmol/l (2
1#ก%%3ก(+
1) Free T4
2) Plasma glucose
3) CT brain
5) CSF exam
/"" 30 A /
#* bus 5 +% 5%ก
'!', 2# AFB 3+, +#".0%" TB "0%'%"3!
(0!
1) 2 wk.
2) 1 mo.
3) 2 mo.
4) '1 1 wk 2ก( AFB 21 neg
5) (25%"3!
/" "3 40 A 125 Asthma %! 2 PTA
#("+'ก(!
7+#".5 ก2(ก" T
37.4 °C BP 110/90 mmHg PR 100 bpm RR 28 /min Lung:
wheezing at both lower lung with accessory muscle
used กกj
%1
3!0=9>""
0!
1) Terbutaline sc
2) IV steroid
3) IV dexamethasone
4) IV Theophyline
5) NB salbutamol
=9>"%?&"
hyperkeratosis onycholysis กกj
%1
3!0=9>""
0!
1) Topical cotrimoxazole 2) Topical itraconazole
3) Topical ketoconazole
4) Oral itraconazole
=9>"%?& !"ก= 1ก8! j1 (
ก ก+'
=7 +ก11ก8!ก
'!ก'8ก"
0=9>""
(21&!*7 0!ก
3!
1) Psoriasis
2) Lichen planus
3) Discoid lupus erythematosus
Pt 50 yr !" +#".5ก2(ก"%'
%' 1 wk, Cholesterol 350, TG 250 221#ก
+!=&%1
42.
43.
44.
45.
46.
47.
1) Eczema
2) Lipoma
3) Xanthelasma
4) Seborrheic dermatitis
%?& 15 A !"ก!
j1!
" 4 ! ก !'1 2-3 20% Prophylaxis
1) Propanolol
2) Sumatriptan
3) Flunazine
4) 1), 2)
5) 1), 3)
=9>"/" 30 yr !
j1ก
"% '2
"
drowsiness, BP 150/110, PR 80, RR 22, stiffness of neck,
Babinski}s sign - neg, Retinal a. - absence of pulse, no
papilledema 0=9>""
(21&!*7 0!ก
3!
1) Migraine
2) Viral encephalitis
3) Subarachnoid hemorrhage 4) Bacterial meningitis
%?& 35 yr %ก 4 wk ก7("$ 2
6"# ptosis mild proximal muscle weakness, normal
DTR, normal sensory 2 Dx
1) Polymyositis
2) Horner}s syndrome
3) Hyperthyroidism
4) Myasthenia gravis
5) CN III palsy
=9>"/""3 21 yr (+ 2 ((+
3 , Total ophthalmoplegia, bilateral facial
palsy, paradoxical breathing, generalized decrease
motor power gr II-III/V, areflexia, loss of vibration sense
all toe and fingers 0!กกj
%1
3!
1) Azathiopine
2) Interferon beta 1A
3) Cyclophosphamide
4) Methylprednisolone
5) Intravenous immunoglobulin
=9>"%?& 70 yr +6"(+ +'1
EKG !
(
ST elevate) 0%"0!ˆกก!ก'(
1) Aspirin
2) Enoxaparin
3) Clopidogrel
4) Warfarin
5) Dipyramidamole
/""ก' ก!(+'1& ˆ 21
! WBC 20,000 +'1 Needle shaped crystal 212 Xray finding 1
1) Osteoporosis
2) Osteophyte
48.
49.
50.
51.
3) Chondrocalcinosis
4) Bone ankylosis
5) Lumpy soft tissue
=9>"/""3 50 A !( 2 !(
"((! 2ก
ก!ก PE: BT 38.5°C,
Rt. knee swelling and marked tender. Lab 0!21
1 "/.ก
3!
1) Serum uric acid
2) Rheumatoid factor
3) Joint fluid analysis
4) ESR
5) Knee plain film X-ray
=9>"/""3 70 A !( 3 !" diclofenac
(!
7 21( ! turbid yellow, WBC 20,000 (PMN 50
%, L 20 %), ESR 50%, gram stain negative (X-ray : no
joint space narrowing, sclerotic rim? no fracture, no
osteolytic lesion) 0=9>""
(21&!*7 0!ก
!3
1) Septic arthritis
2) Pseudogout
3) Gout
4) Rheumatoid arthritis
5) Osteoarthritis
/""3 49 A (
% 28
/" %'( 3 ก( #"' 3221ก& (%' % 5 %ก'! PE: Rt lobe liver enlarged with mild
tenderness, HBsAg positive
LFT: TB/DB = 1.0/0.2, AST = 60, ALT = 70, ALP =
112, Total protein = 5.0, Albumin = 2.3
U/S: Hyperechoic mass at right lobe liver diameter 6
cm, no intrahepatic duct dilatation
='ก&&2"1
1) Metastatic CA
2) Amoebic liver abscess
3) Hepatocellular carcinoma
4) Peripheral Cholangiocarcinoma
5) Postnecrotic cirrhosis with hepatic adenoma
/"" 52 A ก280/" 6"
"#' %'2ก
2
"ก PE: profused sweating, decrease breath
sound Lt. lung, Abd: tender with guarding 2 Dx
1) Hiatal hernia
2) Ruptured esophagus
3) Mallory-Weiss syndrome 4) Tension pneumothorax
52.
53.
54.
55.
56.
5) Acute MI
/""3 40 A !%' 3-4 /wk !*($"
3221
'! +('!(!
"ก3221 0!5+15#'!ก*("'!
1) #&%
2) #&% 9
3) #&% fiber 9
4) '!! Alcohol
5) Š‹ก(*("32210%*9ก&-
3ก
=9>""3 45 A !%''1 1 ! 25 A *("%'
3-4 /d ' 2 !"ก 25?&
(! 2(ก" V/S ก& # scaling lesion &:%
+'1 + 2 * Dx
1) Pellagra
2) Subdural hematoma
3) Wernicke}s encephalopathy 4) Electrolyte imbalance
5) Delirium tremens
=9>"/" "3 33 A dyspnea, engorged neck vein, no
murmur, EKG: low voltage, generalized ST change with
inverted T 0=9>""
(21&!*7 0!ก
3!
1) Constrictive pericarditis 2) Cardiac tamponade
3) RBBB
4) Lateral wall infarction
5) Pulmonary embolism
=9>"/""3 18 A ก%"7
t
/#9 +#".5ก2(ก"2(ก"#(
pink
frothy sputum, crepitation both lower lungs, BP 160/100
mmHg !0% furosemide +'1 O2 กกj#&&
%1
3!0=9>""
0!
1) Digoxin
2) Propanolol
3) Dobutamine
4) Nitropusside
5) Morphine
6) Mg
=9>"%?&"3 32 A Underlying Rheumatic heart disease
with mitral valve stenosis :1
!" Digoxin (0.25mg) 1
tab OD, Furosemide (40 mg) 1 tab OD !" 3 ก(
#. =9> "
ก%"ก ' 2
" % %8
+
=&!ก& PE: BP 100/70 mmHg, HR 50 bpm, Lung
fine crepitation both lung, Heart loud S1, diastolic
murmur at apex 1%3
50%ก&!กก7
1) Hypokalemia
2) Hyponatremia
57.
58.
59.
60.
61.
62.
3) Drug interaction
4) Volume depletion
5) Metabolic alkalosis
=9>"%?&"3 32 A Underlying Rheumatic heart disease
with Mitral valve stenosis :1
!" Digoxin (0.25mg) 1
tab OD , Furosemide (40 mg) 1 tab OD !" 3 ก(
#. =9> "
ก%"ก ' 2
" % %8
+
=&!ก& PE: BP 100/70 mmHg, HR 50 bpm, Lung
fine crepitation both lung, Heart loud S1, diastolic
murmur at apex กกj
%1
3!0=9>""
0!
1) #&" Atropine
2) #&" beta Blocker
3) %"3!" Digoxin
4) #&" Steroid
5) #&" Furosemide
=9%?&"3 60 A 93%
30 A ก X-ray # Right
upper lung mass +'1
Na 0'!5 (urine osm 50) ก&!
2ก1
1) SIADH
2) Polydipsia
Patient CHF † Bx: lymphocyte infiltration, most common
virus?
1) Adenovirus
2) Coxsackie B
3) EBV
4) CMV
/" 65 A U/D AAA 25'! PE: multiple
ecchymoses, $ก&, CBC: Hb 10, WBC 7,200 (N 75, L
25), Plt 30,000, PT, PTT, TT: prolong, fibrinogen ↓, 21
211 "/.
3!0กก%3?
1) D-dimer
2) Euglobulin lysis time
3) Blood smear
#(+('!'9ก+ก HbH disease 21
'9ก
Hct MCV RC
#(
38 72 1
+(
37 87 0.5
* Hb #(+(
1) #( --/αα
2) +( αα/αα
4) #( β/β0
3) +( -α/-α
5) +( β/β+
ก&%'* +'
ก2
" %"02% Na? K?
63.
64.
65.
66.
67.
1) Methanol
2) Ethylene glycol
3) Salicylate
4) Paraquat
=9>"/"%!&
ER ='ก5 EKG !9 (VF)
กกj
%1
3!0=9>""
0!
1) Defibrillation
2) Atropine injection
3) Adenosine injection
4) Adrenaline injection
%?&"3 35 A
ER 1& (ก&59' #&ก
%9
10 8! %'2ก 2 / ก/ก !"กก8
ก/(!
"ก=9>" PE: BT 37°C , BP
140/90, HR 120, RR 14/min with shallow breathing, motor
grade II/V, reflex 1+ *(ก&!2ก#&j1
1) Saxitoxin
2) Tetradotoxin
3) Botulinum toxin
4) Sialotoxin
=9>"0 ICU Subarachnoid hemorrhage 0( ET tube
+'1 Foley}s cath 1 wk (u1
3("
Candida albican กกj
%1
3!0=9>""
0!
1) Itraconazole
2) Clotrimazole
3) Fluconazole
4) Amphoterin B
5) *!" Foley}s cath
%ก:Œ.กŠ‹ก
ก%! '+'1
ก/ก
+#".5ก2(ก" BT 41.1 °C , BP 80/60
mmHg , PR 140 /min RR 25/min 0=9>""
(21&!*7
0!ก
3!
1) Heat stroke
2) Subdural hematoma
3) Dehydrate
4) Encephalitis
=9>"/" 75 A # bed sore 67 (ก 2 Stupor, mild pale, no Jx, no hepatosplenomegaly, Hb 9,
MCV 98, WBC 14000, N90, L10, Plt 20000, PT 18, aPTT
36, PBS MAHA Blood picture 0=9>""
( 21
&!*7 0!ก
3!
1) primary fibrinolysis
2) Vit K def
3) Thalassemia with sepsis
4) DIC
5) TTP
68. =9>"/"""%7 2(ก"125A =''!
!(
TG = 210, LDL = 200, HDL = 30 "00!
(21%1ก=9>""
ก
3!
1) Gemfibrozil
2) Simvastatin
3) Fibric acid
4) Niacin
5) Cholestyramine
69. =9>"/""3 56 A !"28+(%ก!6" 2 /
DM & HT 10 yrs 0% EKG STEMI, V1-V4
%'2ก0% ASA +'กกj0! %1
3!
1) Enoxaparin
2) Warfarin
3) Streptokinase
4) Balloon
5) PCI
70. /" 56 A +8 2 A *("%' 3-4 ( 3 ก(#. 67' BT= 37.3°C, PR = 98, RR = 18,
BP 104/80 mmHg, stupor, mild jaundice, mild ascites,
spider nevi + palmar erythema 21( Investigation 0!#
/("0ก&&2"ก
3!
1) CBC
2) Stool exam
3) Coagulogram
4) LFT
5) Abdominal paracentesis
71. =9>"/""3 42 A 93%
2 6(A 20 A 2
# cyanosis at finger tips, radial pulse 1+, brachial
pulse normal Dx?
1) Raynaud}s disease
2) Takayasu}s disease
3) Polyarteritis nodosa
4) Thromboangiitis obliterans
5) Systemic lupus erythematosus
72. =9>"/""3 60 A !+!( 1 !%. 2(# 3( 50 # WBC 50,000 ,
PMN 80%, sugar 22 (plasma glucose 105) (# crystal ,
5 G/S & AFB negative กกj
%1 1) Colchicine
2) Ceftriaxone
3) Indomethacin 4) Intraarticular steroid injection
5) Anti-TB drug
73. /""3 30 A " 3 ! cachexia, muscular wasting
9(#"-&'"*'& (Capillaria philipinensis) &-
กˆก"(
1) !ก&9
2) !ก&%"
3) !ก&=ก!
4) !ก&'52!!&$
5) !!&'(3(
6) !!5
"(!=( ก3ก
74. %?&"3 42 A !&2ก/
"0%( 2 FU 18
#.ก3# :1ก5''2ก*. ก28ก
! +'1%"02%%" PE: PR 128 /min RR 30
/min lung clear, Rt leg swollen & tenderness ก 0!
ก
3!
1) Pleurodynia
2) Pneumonia
3) Pulmonary embolism 4) Acute coronary syndrome
5) Dissected aortic aneurism
75. /""3 18 A 9 28 3 day 6
! %' moderate
pale, mild jaundice, liver 2 cm below costal margin,
spleen 3 cm below costal margin, Hb 7.9, Hct 28, MCV
65, WBC 9500, N 80%, L 20%, Plt 450,000 0=9>""
(21&!*7 0!ก
3!
1) AIHA
2) HbH with crisis
3) PNH
4) G6PD deficiency
5) DIC
76. =9>"/""3 45 A !%ก 1 !"
ก
1: 1-2 ! 02#ก$ '1 1-2 "#
+#".2#(! 200/120 mmHg !"+(
(5 2!! 210/130 mmHg PR 120
/min RR 22/min 2 Fundus # Flame shape
hemorrhage with early papilledema ก2ก Furosemide
+'210%"'!!
1) Enalapril
2) Propanolol
3) Prazosin
4) Nitroprusside
5) Spironolactone
77. =9>"
anaphylaxis shock treatment "(
1) IM adrenaline
2) Subcutaneous adrenaline
78. =9>"%?&"3 50 A :1!9 .
6t ก!"
" '3ก!&7
!&6 PE : pupil 1 mm +(+
*% lesion
1) Pontine hemorrhage
2) Cellebellar hemorrhage
3) Subarachnoid hemorrhage
4) Basal ganglion hemorrhage
5) Intraventricular hemorrhage
79. =9>"/" 30 A !"= (/!2 &:6
ก
!
"(ก"'/$ ( +(
ก/&:= 0
=9>""
( 21&!*7 0!ก
3!
1) Vitiligo
2) Pityriasis versicolor
3) Tinea corporis
4) Leprosy
5) Syphilis
80. %?&"3 45 A !"%" 2 ! 2(ก" PR 8
heaving, totally irregular, pitting edema, JVP up to
mandible, tapping apex, tapping parasternum, loud P2
(+(
ก*%7ก( loud S1 ???), opening snap
, Diastolic rumbling murmur apex 0=9>""
(21
&!*7 0!ก
3!
1) Rheumatic carditis
2) Mitral valve prolapsed
3) Infective endocarditis
4) Mitral annulus calcification
5) Rupture chordate tendinae
81. /""ก' %" '%"02
ก'&%8 CXR:
cavitary lesion with air fluid level 0=9>""
(21&!*7
0!ก
3!
1) Lung abscess
82. Pt. ก!% $%"$ HT 2# Na 140, K
3.0, %3 HT 1
1) Pheochromocytoma
2) Primary hyperaldosteronism
3) Renal a. stenosis
83. =9>"! penicillin ( diarrhea 2
proctoscope #'กj:1 !ก AAC กกj
%1
3!0=9>""
0!
1) Metronidazole
84. pt pale + jx ( 21(21:
1) Hb typing
2) Inclusion body
3) BMA
4) G-6 PD screening
5) Coomb}s test
85. =9>" Clinical DKA กกj
%1
3!0=9>""
0!
1) i.v. insulin
2) i.v. fluid
86. =9>" clinical DIC กกj
%1
3!0=9>""
0!
1) ATB
2) Plt.
3) FFP
87. 9 EKG PVC 3 &!ก 0=9>""
( 21&!*7 0!ก
3!
1) Ventricular tachycardia
88. 9 EKG complete heart block กกj
%1
3!0=9>""
0!
1) Atropine
89. %?& 55 A Hx smoking Žve, Dx HT 6 mo on enalapril &
amlodipine (
+%$ 2 wk BP 130/70 0%51
1) Off enalapril
2) '! amlodipine
3) On dextrometrophan
4) Inhaled hydrocortisone
5) 5 LFT
90. =9>"%?& 65 A !( 2 2 A!ก'!&,
", '3ก, 7! (ก
"!0'" 2
(# mild tenderness, crepitus (# swelling +'1
deformities 2 Dx
1) Pseudogout
2) OA
3) RA
4) Reactive arthropathy
5) Seronegative arthritis
91. =9%?&"3 25 A u1+! (
UA: wbc = 10-20,
rbc = 0-1 0%"1
1) Ofloxacin
2) Cef-3
3) Cloxa
92. /""3 50 A dx. Bronchogenic CA N/V 25?&
(! V/S stable PE "(=&!ก& lethargy BUN = 30,
Cr = 2, Ca = 14 ก2ก IV fluid 2151
1) Steroid
2) Bisphosphanate
3) Peritoneal dialysis
4) Furosemide
5) Corticosteroid
93. %?& 15 A ก!
j16
ก6"3$ 4 hr ก!
ก7"$ ก(!%8$%"&ก$'2ก3
%7
ก3%7(ก+ ก 3 (!%.
"
0/กjก!=9%?&"
"1
1) Piroxicam
2) Propanolol
3) Sumatriptan
4) Indomethacin
5) Acetaminophen
94. !8ก"3 2 A =(! VSD %'=('5 pulse (! ! BP
(!
!
Ambu =( tube +'10% Amiodarone +'
EKG ventricular tachycardia 2 management
1) Defibillation
2) Ca gluconate
3) NaHCO3
4) Adenosine
5) Direct-current synchronized cardioversion
Pediatrics
1. !8ก"3 5 A !" 28 2(ก"# cervical
lymphadenopathy, Splenomegaly and grayish patch at
tonsil /0!(
/ก( 0=9>""
1) EBV
2) Diptheria
3) GAS
4) Measles
2. !8ก%?&"3 6 A = 3"'8ก$ 0 % %8/!'("
5 3 ! ( PE: Multiple ill-defined, fine
scaly patches, hypopigmented macules and patches %+'1 KOH: negative 20%ก&&2"
1) Vitiligo
2) Pityriasis alba
3) Pityriasis vesicolor
4) Tinea facialis
5) Contact leukoderm
3. =9>"!8ก/""3 3 A "!
'! %''(ก#
Lung: rhonchi right lung ( investigation 1
1) AP, lateral
2) PA, lateral
3) Inspiration and expiration
4) Right lateral decubitus
5) Left lateral decubitus
4. Term newborn BW = 4000 g ! DM /กก8
+'1"8 Blood sugar = 26 mg% 0%กกj!"
5/&!+'1(0!2721%1
3!
5.
6.
7.
8.
1) Oral 10% D/W 10 ml/kg
2) IV 10% D/W 2 ml/kg
3) IV 10% D/W 4 ml/kg
4) IV fluid with GPR 4-6 mg/kg/min
5) IV fluid with GPR 6-8 mg/kg/min
6) IV hydrocortisone 10 mg/kg/day +'1+(
!8ก%?&(
125! 2(ก"# webbed neck,
wide nipple distance and low hair line =&!ก&
=9>""
"9(
. /&!0!
1) Decrease Insulin
2) Decrease GH
3) Increase estrogen
4) Increase GnRH
5) Decrease PTH
!8ก"3 5 A ! ! +'1#=7
ก(200!(
1 "/.0ก1&
prognosis ก
3!
1) CBC
2) ESR
3) Skin biopsy
4) UA
!+'1#=ก!28
+!
% + 20%ก
&&2"
NB 35 wk, 2700 g +( Blood group O, Rh positive 5!&
4 / %''!%' Hct 40% TB = 10 %'2ก0!
(
!ก
3!
9.
10.
11.
12.
13.
1) Sepsis
2) Prematurity
3) Thalassemia
4) G6PD deficiency
5) ABO incompatibility
!8ก"3 2 A 3~#+8+!
"3 1 A"9(*'
"
+'1%!(" 1-2 (!%. '1 3-5 +15"(
1) Pneumococcal vaccine
2) &!tกก
*'
"!8ก
3) 0%ก& antihistamine ˆกก
4) 5 skin test
5) (51 normal !8ก
!8ก"3 2 A 9 1 wk 28 %"02'5ก 2(ก"
# retraction, greenish patch at posterior pharynx and
tonsils 20%ก&&2"
1) Croup
2) Diphtheria
3) Candidiasis
4) Streptococcus tonsillitis
5) Infectious mononucleosis
!8ก"3 6 A U/D Asthma 59ก 2d %ก7 PE:
+! suprasternal, intercostal, subcostal retraction,
inspiratory and exspiratory wheezing, RR 40/min 0%
salbutamol 3 dose 3ก 20 min %"' +(" exp.
wheezing "9( 0:10%กกj1#&!
3!
1) Oral mucolytic
2) Oral antibiotic
3) IV Aminophylline
4) IV Dexamethasone
5) NB. Ipratropium bromide
!8ก 10 A U/D β thal/Hb H '!3ก! +#".
#&2:5 splenectomy ก(
21 Sx ! Vaccine
0! # prophylaxis
1) Typhoid vaccine
2) Influenza vaccine
3) Pneumococcal vaccine 4) Meningococal vaccine
%?& 2 A (+ !&(% PE: mild pale, no Jx nodule % ก
! 6x8 cm cross midline hard
consistency Dx
1) Neuroblastoma 2) Wilm}s tumor
3) ANLL
4) Non-Hodgkin lymphoma
5) Retroperitoneal teratoma
14. !8ก%?&"3 4 A RUQ pain with mass urine: RBC 1020, WBC 1-2 20%ก&&2" 1) Wilm}s tumor
2) Neuroblastoma
3) Lymphoma
4) Hydronephrosis
15. !8ก"3 3 3 +'6
! PE : Moderately pale ,
mild icteric sclera , No hepatosplenomegaly + 2
(ก""(ก& Lab : Hb 7.7, WBC 4,800, Lym !(,
plt 380,000, RC 7.5, MCV 87 21#&
1) Coomb}s test
2) Inclusion test
3) Hemoglobin typing
4) G6PD screening
5) Bone marrow aspiration
16. !8กก&'! =7 %"02
" wheeze
1: anaphylaxis *( first med 1
17. !8ก 1 A 67 1 V/S T 39.8 , PR 140, RR 40, BP
90/60, CBC : Hb 11, WBC 20,000 N 93% , Plt 50,000
Coagulogram : PT, PTT prolong # Petechiae and
necrotic purpura at legs *( ก manage 5? 1) Fluid therapy
2) Antimicrobial
3) Plt concentration
4) FFP
5) Vasopressin
18. !8ก'!
ก&+(+( ecchymosis Vit K deficiency
19. =9>"!8ก % 2 ! 2
(ก"
Ascites, UA : Proteinuria 3+, RBC 0-1/HPF, Fine
granular cast 0-1, Fat oval cast 0-1 150%ก&!ก
1) Decrease Plasma oncotic pressure
2) Increase Plasma Hydrostatic pressure
3) Oncotic pressure 0 cavity #& 7
4) Hydrostatic pressure 0 cavity '!'
5) Increase Vascular permeability
20. !8ก/""3 12 A !"ก' '%!& 1 ก&!
ก&!:1+*/ 2(ก"#(ก&
, neurologic exam normal 51(%(
1) EKG
2) Blood sugar
3) 24hr Holter monitor
4) EEG
5) (51#&&
21. =9>"%?& TB AFB 2+ CXR # cavity '9ก"3 6 !
2 PPD 4 mm *(21 manage '9ก"(
22. !8ก/" 8 A ! '2
" u1(" 3
BP 90/70, PR 120, RR 30, poor perfusion, Lab:
Na 145 Cl 110 HCO3 10, urine ketone 4+
Management 5 !+ก1
1) Insulin
2) 0.9% NaCl
3) Potassium
4) HCO3
23. =9>" newborn 1&+(~. 41 wk with meconium
stain AF + fetal distress 215"(
1) /8! + !
!
2) ET tube + suction
24. !8ก term "3 2 ! '!
BW 4,600 gm PE: BT =
37, PR = 150 AF bulging, mod pale, no jx, CBC: WBC
8,500 platelet 190,000 &!(1
1) Sepsis
2) SDH
3) Idiopathic vitamin K deficiency of infant
25. =9>" newborn 2(ก"# heart murmur, cataract,
&!( congenital infection /0! (Rubella)
26. =9>"!8ก"3 6 ! ก
" +("3 4 ! "ก7% PE: tachycardia, tachypnea,
pansystolic murmur 2/6 at left parasternal border,
cyanosis &!(~10!
1) Hypoxic spell
2) Asthma
3) Pulmonary embolism
4) Breath holding spell
27. =9>"!8ก"3 2 A 4 PTA 38 PE: drooling
ก''5ก, posterior pharynx Dx
1) Acute tracheitis
2) Acute epiglottitis
3) Viral croup
4) Laryngitis
5) Retropharyngeal abscess
28. =9>"!8ก"3 3 A 6
"6
2*7"3 1
A 2ก(!6
ก'" 210% 6
0!0 visit 1) OPV, DPT
2) Hib
3) MMR, OPV, DPT
4) HBV
5) OPV, DPT, JE
29. =9>" newborn preterm GA 32 wk 5%ก+ก'! 1,500
gm %''! 12 / (
ก%"02'5ก *(
!0!0!
1) Spyringomyelin
2) Lecithin
3) Phosphatidyl inositol
4) Phosphatidyl glycerol
30. =9>"!8ก"3 4 A 39 C PE: milky patch at tonsil,
cervical LN 1-2 node ! 2 cm 2 , ก
%"02'5ก liver 2 cm BRCM, spleen 2 cm BLCM 20%
ก&2& "
1) Infectious mononucleosis
2) TB lymphadenitis
3) Streptococcal pharyngitis
4) Diphtheria
5) Lymphoma
31. =9>"!8ก"3 4 A 9> TB 2(ก"(# BCG scar
CXR ก& 5 tuberculin test 13 mm 215"((
1) INH prophylaxis
2) start " TB
3) repeat tuberculin test ก
3 !(
4) ! BCG
5) AFB from gastric larvage
32. =9>"!8ก"3 9 ! ก&+( 5 $ !" para,
amoxy 3 (*("%'5 PE: sunken eyeball,
dry lips, perianal redness (&!(ก&!2ก%30!ก
3!
1) Salmonella
2) Shigella
3) Rotavirus
4) Lactase deficiency
5) Antibiotic-related diarrhea
33. !8ก/" 1 59ก barking cough, inspiratory
stridor, expiratory rhonchi 215"(ก2ก0% IV
1) Ampicilin IV
2) Cloxacilin IV
3) #( beta-agonist
4) #( adrenaline
5) ETT
34. !8ก"3 3 A + Barking cough 2 Mx
1) Adrenaline NB stat
2) Salbutamol NB stat
3) Dexamethasone IV
4) Prednisolone po
35. !8ก"3 7 67 '2 5%'+(
"3 2 ! !
ก3ก, PE: lethargy, moderate
jaundice, erythematous indurated mass at Rt. Breast,
0% ATB?
1) Ceftriaxone
2) Ampicillin + Gentamicin
3) Cloxacillin + Gentamicin
4) Fortum + Amikacin
5) Fortum + Vancomycin
36. =9>"!8ก/" !" Ampicillin 14 %'2ก
" *("%' 5 endoscope #(
hyperemia, Tx?
1) Metronidazole
2) Ceftriaxone
37. !8ก/" "3 8 A ก(+8+!
1&%! 1 PTA,
25'!+'1'!กtu 2 wk PTA, vital
sign ก&, PE: Oozing per gum, petichiae & ecchymosis
trunk & extremities, no lymphadenopathy, no
hepatosplenomegaly, Dx?
1) Hemophilia
2) Acute leukemia
3) DHF
4) ITP
5) APDE
38. ก"3 5 hr /กก8 30 sec 3+ก :1
~.!+8+!
'! C/S APGAR 1 = 8,
5 = 9, " 52 cm, HC = 35 cm ( Ix 0!
1 "/.(ก Dx
1) Plasma glucose
2) Urine ketone
3) E}lyte
4) CBC
5) Serum ammonia
39. Case preterm 32 wk. BW 1,500 g !9%"028$ *(ก&!
2ก~11
1) Respiratory distress syndrome
40. !8ก/""3 4 A 2501("5 %'2ก resuscitation
+'%"02! +(" (("9 7ก 5( ER P.E. : T =
36.5 , PR = 140 , RR = 55 ,BP = 90/60 , drowsy , mild
cyanosis , diffuse fine crepitation and expiratory
wheezing , capillary refill 4 sec , O2 sat 85% On O2 mask
with bag 5 LPM frothy pink 2151
41.
42.
43.
44.
45.
46.
1) IV dopamine
2) Nebulized adrenaline
3) Nebulized bronchodilator
4) On O2 mask with bag 10 LPM
5) Positive pressure ventilation
!8ก 11 A, 1 !ก( (" 25'!, CBC: Plt
5 "(!
", Dx? (ITP)
!8ก/" "3 15 A *กกก 2 A 2(ก" #
Upper/Lower motor weak gr IV/II DTR no impaired pain
and touch, glottic stroking pattern
1) Beri Beri
2) GBS
!8ก!"ก Drooling, miosis, dysphoresis, profuse
sweating *( ก&!2ก0!
1) Ethanol
2) Organophosphate
3) Opioid
4) Ephedrine
5) Cocaine
ก"3 6 / +ก'!(!9! %"02%%" tu
Breath sound !!
" "%02"9( Xray # heart Rt. chest "3 2 Dx.
1) Situs inversus
2) TE fistula
3) Diaphragmatic hernia
!8ก%?&"3 10 A =ก %02 +(ก5&! "
กกj!"%02'%'%'"$'8ก$ "3 3 A
ก%""' !"%"ก7 2 !
! PE: central cyanosis, clubbing finger, Loud
P2, diastolic rumbing murmur 3/6 at Lt upper parasternal
border lung: clear 0! (21%3ก%"0
!8ก"
1) Pulmonary embolism
2) Aortic regurgitation
3) Hypoxic spell
4) Eisenmenger complex
5) Congestive heart failure
!8ก"3 7 5 %ก+ก'! 2,800 gm ก&+'2
"
5
%' %'2ก67 !9!"' 5%ก'!%'
2,400 gm 2 Dx. 1) Duodenal atresia
2) Pyloric stenosis
3) Inborn error metabolism 4) Sepsis
47.
48.
49.
50.
51.
52.
53.
5) Hirchsprung disease
=9>"!8ก%?&"3 9 A ก%3!%&!(" ก
"ก
5' PE: Thyroid diffuse enlarged, exophthalmos,
smooth skin. PR 120 FT4 #& TSH '! Antityroglobulin
1:1,600 21กj"(
1) Iodized oil
2) Iodized salt
3) Lugol solution
4) Methimazole
!8ก 7 A +'13(5 1 Dx ( Chickenpox +15+((210%!8ก !
1) %'2ก'!
2) +='ก1ก8!%!
3) 3(508!3!"'ก
4) %'ก& Acyclovir 48 hr
5) !'" +(0%&!/&!
!8ก %"02%%" ก'&%8 hyperpnea, +ve urine
ketone 4+ Dx 1
1) DKA
2) Sepsis
3) meningitis
=9>"!8ก/""3 9 mo !" otitis media " &!
/$%"$ +( 3 mo ก( #ก pneumonia,
S.pneumo, Hib, *((
defect 0!
1) B cell
2) T cell
3) Phagocytic defect
4) Complement
!8ก"3 4 A !"+'167 BP = 90/60 mmHg, PR =
120 /min 2(ก"#23! Stiff neck positive /
%3กก&! 0=9>""
ก
3!
1) Salmonella
2) N. meningitides
3) L. monocytogenes
4) S. pneumonia
5) H. influenza
!8ก 10 mo 5 3ก 3 mo ก %"02%
%" inspiratory stridor, chest drawning ~"%'0%
epinephrine %"' epinephrine ='"(
1) ""%'!'
2) %1
3) 5
0!
4) '!"3!&%"02
! DM !8กก&!
ก sign hypoglycemia DTX 30 Hct 63 * Management
54.
55.
56.
57.
58.
59.
1) Early feeding
2) Bolus 10% D/W 2 ml/kg
3) Plasma exchange
!8ก/""3 4 mo 67' WBC 18000 (N 80%), Hct 6.9%,
Dx 1
(Subdural hematoma)
!8ก"3 4-5 59ก%'ก'&%8 กj!" Amoxy 2
ก(!
7 #+#".2#%0/(29กก
51(
1) ( X-ray PNS
2) 2!" nasal speculum 65
ก
3) Amoxicillin/Clavulinic acid
4) 0/ Amoxycillin !&(
5) Consult &ก+#".
!8ก00!
#‘ก/
1) "3 10 ! (!
2) "3 12 ! !&!
3) "3 2 A !&ก7!'!
4) "3 3 A #9!5 !!! '
10-20 5
5) "3 5 A !9%'
"!
!8ก%?& UTI กj!" Ampicillin 14 2ก
! 7 %' 3221
WBC = 1-5, RBC > 100
(ก' scope !92 Patch? 0%"1
1) Cotrimoxazole
2) Norfloxacin
3) Metronidazole
!8ก/""3 6 A +(#2ก
truncal obesity ,
Buffalo hump , moon face c acne , " 212#&&
#1
1) Hypocalcemia
2) Hyperkalemia
3) Advance bone age 4) Increase serum cortisol
5) Increase activity of rennin
!8ก%?&"3 4 yr 6
! 2 wk ก(%
ก& PE: Pallor,
petichiae &:+ CBC Hb 7, Hct 22, WBC 3200 (N
35, E 3, L 62), Platelet 26000, MCV 90 21( Investigation
1#ก&2& "
1) Serum ferritin
2) Bleeding time
3) Reticulocyte count
4) Screening coagulogram
5) Bone marrow aspiration
60. !8ก%?& 9 ! ก&+'5'ก(" ! 3 BW 7 kg PR 120 lung: wheezing both lung, CXR:
perihilar infiltration, PPD 4 mm %'! brochodilator +'!
7 Dx
1) Retained FB
2) Diaphragmatic hernia
3) TB
4) GERD
5) Asthma
61. !8ก"3 6 !ก13ก/ 2 !%. !"&2ก
=ก
j1ก(+'5( ก! 2&&2"
62. !8ก/""3 19 A #+#".%'2ก*tuก
+#". +''!%'67(%"3! 2+'1( 2
'! PTT 50 sec (control 30 sec), PT 13 sec (control 14
sec), no prolonged bleeding time %3กก&! 1
1) Lupus coagulopathy
2) Factor VII deficiency
3) Factor VIII deficiency
4) von Willebrand factor deficiency
5) Hereditary platelet dysfunction
63. !8ก 3 A %"(" mild pale other WNL %ก 13.5 kg ,
blood smear : hypochromic microcytic anemia
1) Iron deficiency
64. '! Vacuum extraction %''!
j1 '!
+ก'
j1+("9( #1
%30!!ก
3!
1) Cephalhematoma
2) Epidural hematoma
3) Subdural hematoma
4) Subgaleal hematoma
5) Caput succedaneum
65. !8ก/""3 5 u1
5'+'1%"("
2 u1ก 100 cc/day PE : BP 150/100 , Heart
: S3 gallop, Lungs : fine crepitation both lower lung, Liver
3 cm below RCM, EXT : mild pitting edema 210%ก
กj1'5!+ก
1) Lanoxin
2) Prednisolone
3) Furosemide
4) Restrict sodium
5) Hydralazine
66. !8ก/""3 8 !
59ก 2 %
%"02'5ก ก&!'!' 2(ก" BT = 38.2°C, PR =
110/min, RR = 52/min, BP = 90/60 mmHg, O2sat = 92%,
Lung : expiratory wheezing both lung, CXR : generalized
hyperinflation both lung 2กกกj
%1
3!0
=9>""
2) IV fluid
1) O2
3) IV adrenaline
4) NB salbutamol
5) ET tube
67. !8ก/""3 9 #"'!"9 %"02%
%" +#".5 ก2(ก"#(
BT= 39.0°C,
PR= 120 /min, RR = 40 /min, crepitation both lungs,
decreased breath sound left lung =9>"
+='3(%
+'1 cellulitis 6" /ก( 00!(
(2150%
ก&!ก0/"=9
ก
3!
1) Salmonella spp.
2) S. aureus
3) H. influenzae
4) M. pneumoniae
5) M. tuberculosis
68. !8ก%?& 6 25'! $ %"$ 1 ! PE:
generalized ecchymosis CBC: Hb 12, Hct 36, WBC =
8,500, PMN = 55%, Lym = 30%, Eo = 15%, Plt =
154,000 with pale stain 2 LAB 1=&!ก&
1) PT
2) aPTT
3) Bleeding time
4) VCT
5) TT
Surgery
1. =9>"/"""3 47 A ก"3$ $ %
$
%"$ 3 A #+#".
#"' =9>"!"
ก+'1 ก7 ก!28ก+'1!กก'(!
+( 5 / ก( #"' กB&&00!
%1
3!0=9>""
1) Analgesic
2) Try reducing
2.
3.
4.
5.
6.
3) Observe and plan admit 4) Surgery
5) Reassure and plan discharge
=9>"/""
ก!
&: epigastrium :1
#7!%'! 2 +ก #+#".
#"'
+#".!5 ก2(ก"# Abdomen : generalized
guarding, absent bowel sound ก(200!
%1
3!0=9>""
1) Plain abdomen
2) CT abdomen
3) Ultrasound
4) Abdomen series
5) MRI
=9>"%?&"3 22 A '5!ก
3 !ก(
2(ก"#ก ! 2 cm oval shape, firm, smooth
and movable ก&&2"00!!ก
3!
1) Fat necrosis
2) Fibroadenoma
3) Fibrocystic disease
4) Intraductal carcinoma
5) Intraductal papilloma
=9>"/" 56 A 1&#
/" 18'5
0%?(+'
"/
& 272(ก" 5 colonoscopy #
polyps at descending colon +#".5 polypectomy ก
2#00!
ก#‘18ก3!
1) Villous adenoma
2) Tubulovillous adenoma
3) Tubulous adenoma
=9>"/" hernia testis ! 1 / ก(
#"' กB&&00!%1
3!0=9>""
1) Reduction
2) Ultrasound
3) Surgery
4) Radiation
5) Reassure
=9>"/""3 30 A ก28+'1!&:*3:Œ1
!6" 5 ก( #"' ก2(ก"
#(
ก! +! ก28'!'"ก
*3:Œ17 +#".2( 2 Ultrasound #
increase vascular blood flow ก&2& "00!!
ก
3!
1) Orchitis
2) Epididymitis
3) Incarcerated hernia
4) Acute torsion testis
7.
8.
9.
10.
4) Torsion of appendix testis
=9>"/""" (ก กj2%"!
+'
+("
ก23ก+( ! % 5 %ก'!
2# pseudocyst at the front of pancreas +( 4
!%.ก( ก 7"(!8 กB&0& 0!
%1
3!0=9>""
1) Partial Pancreatectomy 2) Total Pancreatectomy
3) Excision of pseudocyst 4) Internal drainage
5) Percutaneous drainage
=9>"/" !%&2
"ก1!8& :1ก5'5
5+%(
!0ก''9กก1!ก 30 ก( #"'
/(+ก
!+='
'!ก2%1ก%02,
!! '%&! 86/70 mmHg :1
'!%"3!%'+'
+=' laceration 3 cm anterior to sternocleidomastoid
กB&&00!%1
3!0=9>""
1) Explore wound at ER
2) Explore wound at OR
3) CT
4) MRI
5) Angiography
%?&"3 16 A ก
! ก!1: 2
cm. !#-.ก! +#".2(ก"#(
well define 2.5 centimeter mass, firm consistency at the
right breast กB&&00!%1
3!0=9>""
1) 0%2!"
2) #+#".0%2
3) Fine needle aspiration
4) Ultrasound %'2ก!2&!3ก$ 6 !
5) Mammogram %'2ก!2&!3ก$ 12 !
=9>"/""3 35 A !%'&!(ก 5 ก!
ก 2 !%' =9>"+'ก!!
7 +#".5 ก2(ก" Abdomen - tender at
epigastrium, liver dullness, decreased bowel sound ก
&&2"00!!ก
3!
1) Alcoholic gastritis
2) Bowel perforation
3) Acute pancreatitis
4) SBP
5) Cholecystitis
11. =9>"/" "3 35 A *("3221
'! $%"$ 6
! !" 3 ก( #. '5ก!(& %+( &
!ก'! กB&0& 0!%1
3!0=9>"
"
1) Injected 5% phenol
2) Rubber band ligation
3) Hemorrhoidectomy
4) Cryosurgery
5) Reassure and follow up
12. =9>"/""3 65 A!ก&2& "( Colorectal
Cancer 1 !ก( = 9>" #"'!"
ก!3+ 3 / ก( #"' +#".
5ก2(ก"#(
restless, body temperature =
39°C, Blood Pressure =100/70 mmHg, Pulse Rate
=110/min , Respiratory Rate = 26/min generalized
abdominal tenderness, guarding, rebound tenderness,
absent bowel sound ='2กก( Acute abdominal
series #(
generalized bowel dilatation with
intraabdominal free air +#".20%"B&/
1
00!(
1ก(5ก((=9>"
1) Ceftriazone + Metronidazole
2) Clindamycin + Gentamicin
3) Clindamycin +Ceftazidime
4) Ampicillin + Gentamicin
5) Ceftazidime + Gentamicin
13. =9>"/""3 35 A !!282ก3&%3&ก ก!
ก1!9ก6
!+#".125%3ก&
5ก2(ก"#(
trachea shift !6", Right
pneumothorax (0%9'+ tension pneumothorax)
กB&&00!%1
3!0=9>""
1) Pleural tapping
2) Observe vital sign
3) Oxygen mask with bag 4) Emergency ORIF
14. =9>"/""3 31 A !!282กก*9ก+
left
parasternal border 5 ก( #"' Blood
Pressure drop +#".125%3ก&5ก2
(ก"#(
distant heart sound กB&0& 0!
%1
3!0=9>""
1) Echocardiogram
2) Pericardiocentesis
15.
16.
17.
18.
3) CT chest
4) MRI chest
5) Observe vital sign and clinical sign and symptom
=9>"/""3 13 A !!282ก3&%3.6!.
'+#".125%3ก&5ก2(ก"#(
stupor +'1!5 ก2 !" CT scan ='#(
crescent
shape hemorrhage +'1 hyperdensity area ก&2& "0
0!!ก
3!
1) acute epidural hemorrhage
2) acute subdural hemorrhage
3) subacute epidural hemorrhage
4) subacute subdural hemorrhage
5) subacute intradural hemorrhage
=9>"/""3 14 A !!282ก3&%3.6!.
'+#".125%3ก&5ก2(ก"#(
Blood pressure drop 1& Glasgow Coma Score = 8
กB&&00!%1
3!0=9>""
1) Cervical Collar
2) ET intubations
3) CT and MRI
4) IV fluid and dopamine if necessary
5) Refer to the nearest hospital immediately
=9>"%?&u1(ก u1 2 =( =9>"!"ก(+ +'1
ก/*71!1! +#".1255ก2(ก"
#( Loose sphincter tone, areflexia both legs =9>"
(21
#"-&~#*71!0!
1) Parasagittal
2) Basal pons
3) Thoracic cord
4) Lumbosacral nerve root
5) Conus medullaris
=9>"/""3 14 A 5%ก(ก8(9(
02!ก'"
burn 1st degree burn = 4% &:%, 2nd degree
burn= 27% 15 ก( (
inhalation injury 0%
50/ +ก( Parkland}s formula
1) 200 ml/hr
2) 250 ml/hr
3) 290 ml/hr
4) 340 ml/hr
5) 390 ml/hr
19. =9>"/""3 52 A !%ก'(6"
%'2
"
3+ +#".125%3ก&5ก2(ก"#(
Leftt lung decrease breath sound, Abdomen: tender with
guarding ก&&2"00!!ก
3!
1) Hiatal hernia
2) Esophageal rupture
3) Tension pneumothorax 4) Mallory-Weiss syndrome
5) Deep neck infection
20. /""3 24 A Intracranial bruise, chemosis , 2 Aก(
severe head injury !กกj
#"' ก&&2"00!!ก
3!
1) Intraorbital abscess
2) Carotid cavernous fistula
3) Chronic subdural hematoma
4) Posttraumatic hydrocephalus
5) Ruptured ophthalmic aneurysm
21. /""3 18 A *9ก%ก!% ~#".
& !
2x1 cm ( 2".(!ก'กj:1!+=') %'2ก'
+='+'1! tetanus toxoid กB&&00!%1
3!
0=9>""
1) Rabies vaccine
2) Rabies Ig
3) Šˆ!9ก3 1 !%.
4) !%3(2+'1tu='
5) Rabies vaccine +'1 Rabies Ig
22. /" 70 A u1(" u1(3! u1ก(
ก& u1(#3( +'1
u1%"!%'2กu182
2 PR: firm, slightly enlarged and firm prostate gland,
UA: normal ก&&2"00!!ก
3!
1) Urethral stricture
2) Acute prostatitis
3) Prostate cancer
4) Neurogenic bladder
5) BPH
23. /""3 20 A 13& %3*".%"02! "
+% BP 110/70 2(ก" loss of laryngeal
prominence # subcutaneous emphysema cervical
กB&&00!%1
3!0=9>""
1) Orotracheal intubations
24.
25.
26.
27.
28.
29.
30.
2) Nasotracheal intubations
3) Nasal Orotracheal intubations
4) Tracheostomy
5) Cricothyroidotomy
Pt. cholangitis ก 3 U/S: gallbladder
thickening % acute cholangitis ! supportive !"
NPO + ATB 2!
7+' กB&&00!%1
3!0
=9>""
1) 0% ATB (2 14 2) LC
3) !=(!
ก 6 wk
Pt. !8ก ! 6 hr 2# tender at RLQ , + rebound
tenderness 215"(
1) Observe abdominal sign
2) Emergency surgery
X-ray # mediastinal shift, bowel 70 thorax
1) diaphragmatic herhernia
+=' bedsore '7ก*7 sacral bone 5+='2
granulation !
+'21 manage "(
1) Wound healing 2) Local flap
3) Distant flap
4) Full thick graft
5) Partial graft
%?& 64 A !'&Ay 6 ! mild jaundice, soft scaphoid,
TB = 16, DB = 10, ALP = 300 21 Ix 1
1) CT abdomen
2) U/S
3) Radionucleotide scan
4) PTC
5) ERCP
/" 19 A 13& %3*/%!& BP 90/60 PR 120
RR 24 Abd: distention 51!+ก
1) CT brain
2) Blood transfusion
3) C-spine protection
4) ET-tube
5) DPL
/"""3 40 A ก
:Œ1 10 A '"3ก'
! %
!1/. :Œ1 7 &
“&&
1) reduction
2) acute abdomen series
3) abdominal ultrasound
4) IV antibiotic
5) surgery
31. /"""3 22 A # !"3&%3*2ก"". !"ก%"02'5ก 2(ก"+'1 x-ray # absent breath sounds, tracheal shift 2&2& "ก
(Tension pneumothrorax)
32. =9>"%?&""3 18 A #+#".!"#ก
2 ! ก('
125!ก21 ก7
+'1!'! +('(
125! ก21"3+'1
ก!%" PE: well-defined mass 2 cm in diameter
, firm consistency , mild tenderness at UOQ 2 manage
1) 2 self-breast examination
2) !23ก 3 !
3) FNA
4) Mammogram *ก&!23ก 2 A
5) Ultrasound *ก&0%!23ก 1 A
33. !8ก 6 yr ! vaccine 5 yr *9ก+(! 2 cm
! vaccine 1
1) Rabies vaccine
2) TT
3) Rabies vaccine + Tetanus toxoid
4) Rabies vaccine +'1 Rabies Ig
5) TT + Rabies vaccine +'1 Rabies Ig
34. Motorcycle accident lesion T2 " Foley Catheter
ก+(%ก %กก7 BP 180/110 RR #&
5"(
1) off F/C 2) Hydralazine 3) '3ก'!=
4) %5! BP 65
5) ADVICE
Ob & Gyn
1. %?&""3 32 A G2P1 GA 24 wk 1&&!>"
% ก2!ก00!(
%1
3!
1) Fasting blood sugar
2) 50 g OGTT
3) 100 g OGTT
4) Random glucose
5) Urine sugar
2. =9>" G1P0 GA 34 wk 5%'ก2ก/('! ก'
(! 2!" sterile speculum # fluid posterior
fornix +'1 fern test: positive 0!(
%50=9>"
"
1) Tocolytic drug
2) Dexamethasone
3) IV prophylactic ATB
4) Observe sign of chorioamnionitis
5) PV #!9 progression "((
3. =9>" G2P1 GA 38 wk uterine contraction 3ก 3 30 &
Cervix dilate 3 cm, 50% effacement, station 0,
membrane intact 2 PV '5!%!8ก+'1'"&!8ก
กก150!(
%1
3!
1) Amniotomy
2) Syntocinon
3) U/S
4) Observe
5) C/S
4. =9>"%?&"3 28 A mitral stenosis ~.! 8
!%. 5!ก& % "#1'กก5'ก"
! (%%" Šก~.ก(210%
5+15"(
1) ~.! '!!ก&
2) ~.! +(=(!'&%02ก(
3) ~.! +(( tertiary center
4) "3&ก~. '9ก
ก#&ก9
5) "3&ก~. +(
ก
"/
&9
5. %?&"3 26 A GA 8 week ก2 Ultrasound #!9 GA
00!+("5
3!
1) Femur length
2) BPD
3) CRL
4) Abdominal circumference
5) Head circumference
6. %?&"3 24 A G1P1†. Hydramnios ! oxytocin '!
Vaginal delivery %''!
bleed 1500 ml '!ก"ก
(
bleed ŠA"8 PE : Uterus ½ FH > umbilical 0!
%3 post partum hemorrhage
1) ~.+ก
2) Hydramnios
3) '!ก"ก
4) ! oxytocin
7. =9%?&"3 30 A ~. term '!%+' &!%'(% 5
maneuver 1
1) McRobert maneuver
2) Modified crede
3) Zillneuing †.
8. =9%?& G4P3 GA 38 wk true labor PV: OS open 7cm 2
cord Fetus Normal Most approp Mx (&!( C/S)
9. =9%?& 9 Vulva Herpes *(21'!"(
(NL, C/S,†)
10. %?&"3 28 A G1P0 GA 38 wk !ก(#. 2 /.
FH 3/4 > 1! FHR 150 at RLQ Cervical os closed ,
ANC USG at 3 trimester # mass 8 cm @ anterolateral
lower uterine segment 21+='!?
1) Normal delivery
2) Cesarean section
3) Cesarean section with myomectomy
4) Cesarean section with hysterectomy
11. %?& (
3 กก'&%8 (1
1) wet smear
2) G/S
3) C/S
12. ก'!&!%'( 0!(52ก"ก
3!
1) ! perineum ก7
2) =9/("ก! suprapubic
3) =9/("ก! fundus
4) flex hip (&!
5) ("$!7!8ก'/$!"+
13. %?&"3 28 A S/P C/S Day 2 !7 5 ก!
! (!+=' 5'
+!"ก(+ก
3221 u1ก& PE: T 38°C, Breast marked engorge
and tenderness, Abd mild tenderness, +='!
(
oozing
(/7 ( bleed mild tenderness, MIUB: WNL, Cx: tender
on motion, lochia rubra, no mass, Ut: mild tender, 20 wk
size, Adx: tenderness both sides Dx
1) Mastitis
2) Breast Abscess
3) Pelvic infection
4) TOA
5) C/S wound infection
14. =9>"%?&"3 52 A 9(" menopause ก+'6
"
'1(
15.
16.
17.
18.
19.
20.
1) 300
2) 500
3) 800
4) 1000
5) 2000
=9>"%?& 1&"0( IUD !125! 6
!%. 215"((
1) Ultrasound
2) X-ray
3) ( urine pregnancy test
4) 0/ hook ก
" IUD ก
5) 0( IUD 0%(
=9>"%?&"3 39 A 5 %ก 65 kg 9 152 cm ˆ
% '9ก+ก5 %ก+ก'! 4200 gm 0!
risk ( DM =9>""
ก
3!
1) 2) "
3) ˆ%
4) '9ก macrosomia
5) "3 > 25 A
%?& "3 18 GA 5 wks 3ก(" spina bifida
ก&1#ˆกกก&!65
1) Iron
2) Zinc
3) Ca
4) Folic acid
5) B6
Female 18 yr GA 12 wk G1P0 '!ก/('! (
+!!5) (
/&%'3!ก !%(&:"
PE: '!+!!50/('! (#/&
ก!'9ก
ก!'9ก—! !'9ก ! 8 wk ก!28'8ก" Aก!'9ก(
28 (
mens " cervix (28 Diagnosis?
1) Threatened abortion
2) Complete abortion
3) Inevitable abortion
4) Imminent abortion
5) Incomplete abortion
%?& GA 20 wk 2ก LMP 25!+( 2#
fundal height 9ก( umbilicus ¼ 215"(
1) ultrasound
2) 0% void ก( +'20%(
Pt. pregnancy BP 140/90 mmHg, urine alb 1+ 20%ก
&&2" (Mild preclamsia)
21. +( 7 ! ~.
3 '9ก 2 +ก 1&
Asthma 21+15+("(ก
" กกˆก(0%
Asthma 0~.
1) ก&+((
2) ก& soy formular milk
3) ก& Hydrolysated extend casein formular
4) %0%+(ก&%%
(= 0
5) '9ก'! +'2 Serum IgE #+=กกj
(
22. +( TB '
"'9ก!"+( '9ก(
ก Tuberculin test
! 4 mm 5"(?
1) กj TB
2) INH prophylaxis 1 month
3) Observe chest X ray ก 6 !
23. %?& 21 A LMP 6 wk. !"'!ก vagina !
ก'" PV: uterine normal size, soft, no adnexal
mass, not tender, TVS: no intrauterine sac, no mass,
Mx?
1) D&C
2) Serun ß-hCG
3) Exploratory laparotomy 4) Diagnostic laparotomy
5) MTX injection
24. =9>"%?& "3 28 A "3ก5&! !
+6"
3 , 5$ 2"1# # swelling, tender, red
labia minora 2.5 cm 2 $ก& Tx?
1) Incision biopsy
2) Excision biopsy
3) Masupialization
4) I&D
5) Needle aspiration
25. %?&"3 24 A G1P0 GA 6 wk bleeding PV 2'!
ก!'9ก Ut. '8ก" U/S %8 Double decidual sac
sign
1) Demise embryo
2) Implant bleed
3) Ectopic pregnancy
4) Intrauterine pregnancy
5) Anembryonic pregnancy
26. %?&"3 30 A !"กก ( (
t ก'&
%8 5 Wet smear 10%KOH !! 9 (9 epithelium =
clue cell) "
%1.
1) Amoxicillin
2) Doxycycline
27.
28.
29.
30.
31.
32.
3) Metronidazole
4) Ceftriaxone
5) Ofloxacin
%?& GA 38 wk term 28'! mucous bloody
shown, cervix dilate 3 cm. Vx, !8ก FHR 144/min 2
~"0!9 ('กj:1% Rt labia major lesion ulcer +!$ %"ก$ %
discharge 2ก vagina) Mx.
1) 0%'!ก&
2) 2
podophyline +' NL
3) 2
TCA +' NL
4) 2
Silver nitrate +' NL
5) Cesarean section
%?& 30 A ~. 3 ! ก!+'&Ay " EGD
# DU 210%"0!
1) Omeprazole
2) Misoprostal
3) Sucralfate
4) Ranitidine
5) Cimetidine
%?&"3 30 A GP1021 GA 38 wk in labor 27 Drip
Syntocinon (! BP ! 80/50 mmHg '5 Fetal
part !/! 2+(tu Fetal heart sound (! 2 Dx.
1) Abruptio placentae
2) Placenta previa
3) Uterine rupture
4) Vasa previa
5) Prolapse cord
=9%?&"3 40 A G2P1 GA 8 wk "0ก Down
syndrome 21(
1) 1/50
2) 1/100
3) 1/200
4) 1/300
5) 1/400
=9>"%?& 38 A G4P3 GA 39 wk, no ANC, 2hr PTA 9ก
'!ก2ก/('! *7 #.
5!&, contraction
5} 30š, PV: 7cm,station -2 '5!ก +'1"1!
Management 1
1) Observe
2) 0% syntocinon
3) Partial breech extraction 4) Total breech extraction
5) Emergency C/S
=9>"%?&~. 8 wk 125 Mitral stenosis (ก"+8+ ก%"
"9(#1/(กก5'ก"
21#&2:("(
33.
34.
35.
36.
37.
38.
1) ~.(+'10% '!ก&
2) ~.( †††††††
3) ~.( +(0%Šก~.
Tertiary care
4) %"3!~.2ก"(+(
5) %"3!~.2ก"('9ก
%?& 28 A G6P5005 ~.ก5%! !2
~"ก#!8ก"90( ( transverse lie ก!'9ก—! 4 cm.
215"(
1) 0% cytotec
2) 5 external version
3) C/S
4) 0% Cx —!8
5 Internal version
5) 0% Voohees ก(ก!'9ก—!8
=9>"%?&"3 60 A ! '%&9 %!125!
9 A '!%'ก2กก!'9ก2 $ 2 ! vital
sign stable !
5"((
1) F/U 6 mo
2) Colposcopy
3) Endometrial ablation
4) Endometrial sampling
5) OCP
=9>"%?&"3†. G1P0 GA 32 wk PROM 1 hr 1
Contraindication #/.
(
ก3+#". #5ก refer
1) 0% steroid
2) 0% O2
3) 0% Antibiotics
4) 2~"01& Progression cervix 1"1
risk factor uterine atony: Polyhydramnios
=9>""3 40 A G1P0 GA 16 wk 5 amniocentesis !
increased AFP '9ก
risk 1
1) Cleft lip
2) Bilary atresia
3) Duodenal atresia
4) Neural tube defect
5) Esophageal stenosis
!8ก%?&"3 14 A 3 !" ก7 97ก"
9 7 Aj
!"/($ *("u1
("7 "(
1!9 +'1%%(7 2 A
2(ก" abdominal : tense cystic mass , 1/3 >
suprapubic , labia majora : normal , Gaping labia minor
with purple tissue , PR : pelvic mass 12 cm , cystic
consistency
39.
40.
41.
42.
43.
44.
45.
46.
1) Vulva CA
2) Ovarian tumor
3) Imperforated anus
4) Sarcoid boterioides
5) Foreign Body in Vulva
%?&"3 35 A P1021 G4 ! Oxytocin drip (!
BP 130/100 FHS (/! +8'! #!
2/3
" 2&2& "
1) Myoma uteri
2) Full bladder
3) Theated Ut. Rupture
4) Hypertonic UC
"3 28 A '!%'กก1—!ก1"/('!
3 %'2ก1"8!3ก5&!+=+ก! 2
!%. (
5+15"(
1) %"3!"3ก5&!+=
2125!
2) '
"&-
ก3ก5&!
3) 1 Conjugated estrogens 0.625 mg 2
21 4) ก&ก&!0กก&"3ก5&!+=+ก 21ก&
0
ก 3 !%.
Pt. severe preclamsia GA 33 wk "(
cervical change
1) induction with oxytocin
2) induction + painless labor
pt /" 14 A
primary amenorrhea 2# mass suprapubic ! 10 week size firm PV # normal
labia major bulging vagina : Imperforate hymen
'!ก~. +150%5%ก#&(ก&ก
ก& 'ก
1) 10
2) 12
3) 14
=9>"%?& 20 A 125!( 5 !%. 2#
cervical 3( $ ก& U/S ก& 5"(( : serum hCG
%?& 28 A '!3+ก "3 6 wk '
"!"+(
ก3ก5&! 2-3 A Hx dysmenorrhea 'ก
3ก5&!!"&-
1
1) Condom
2) IUD
3) Combined pill
4) Progesterone
=9%?& "3 28 G1P0 GA 33 23ก+('&Ay BP
170/120 P 90 FH 2/4 > O FHR 140 albumin 2+ %'0%
MgSO4 +'1"'!!+'5!
1) Expectant + Manage !"&! NST
2) Induction of labour !" Oxytocin
3) Induction of labour %8 PGE2
4) Induction of labour + painless labour
5) Urgent C/S
47. %?&""3 36 A +( 4 A ("3ก5&! (
3
!125!3+3ก!2%"3!PV: fixed
cystic mass 5cm at Rt. Adnexa, nodular at cul-de-sac Dx
1) Follicular cyst
2) Dermoid cyst
3) Endometriotic cyst
4) TOA
5) Corpus luteal cyst
48. %?&"3 30 A PV 2 mass Aก!'9ก! Pt.(
ก1 U/S # 3 cm homogenous hypoechogenic
cyst 0(
content Rt.adnexa Dx
1) Hemorrhagic cyst
2) Endometriotic cyst
3) CA ovary
4) Fuctional ovarian cyst
5) Polycystic ovarian syndrome
49. !8ก%?&"3 14 A (
125! 8 ! (
ก
(
02/ % กก=&!ก& B&-5%'
=&!ก& (!'!5%ก %กก5'"(%ก % 2
(ก"(#=&!ก&0!$ 5 progesterone challenge
test: negative +'1 estrogen-progesterone challenge test:
negative ก&&2"0!%1
3!
1) Ovarian failure
2) PCOS
3) Exercise amenorrhea
4) Asherman}s syndrome
Ortho & Rehabilitation
1. =9>" RA '8ก" swan neck 5 modality
0!
1) block exercise
2) tension-gliding exercise
3) low-load, high repetitive resistant exercise
4) high load, high repetitive resistant exercise
2. =9>"/""3 22 A 3& %3 ก!1 #ก
2# flexion, abduction, internal rotation *
diagnosis
1) Fx pelvic
2) Fx acetabulum
3) Fx neck of femur
4) Intertrochanteric Fx
5) Posterior hip dislocation
3. =9>"!8ก/""3 10 A 13&%3*2ก"". ก!ก "ก(! PE:
swelling at Rt elbow, triangle landmark at Rt elbow 20%
ก&2& "
1) Dislocation elbow
2) Displaced olecranon fracture
3) Displaced supracondylar fracture
4) Displaced lateral condylar fracture
5) Displaced medial condylar fracture
4. =9>"/""3 59 A ! 2# Biceps (+ +'1
reflex '! (21
#"-&~#
ก10!
1) C5
2) C6
3) C7
4) C8
5) T1
5. =9>"/""3 20 A %ก':1'(t3' %'( 5
X-ray # fracture neck of humerus ก'0!
2ก&!
ก(+!
1) Deltoid
2) Brachialis
3) Biceps
4) Triceps
5) Coracobrachialis
6. =9>"%?& 52 yr !ก' '3ก1!+'!
7 PE: sensory intact, no thenar atrophy, Phalen test +ve
Tx 1
1) Observation
2) NSAIDS
3) Epidural steroid injection 4) Long arm cast
5) A1 pulley release
7. Pt %?& 69 yr , OA !( genu varum
+15"(
1) กก5'+ isotonic
2) 0/6"
3) กก5' isometric #& Hamstring strength
4) &! medial
8. =9>"%?&"3 50 A !'+6"1: 1
! !5 cervical traction '1 30 %ก 5-8 kg
1 wk (!
7 +'1+8ก8!&'5ก 5
"(!
1) #&5%ก traction
2) '
" traction 3) #& physical modality 4) %"3! traction then MRI
5) 0%"'!ก8 + "+ก!
9. '!&!%'( 4 5 wood crocscrew maneuver
%''!2(ก"# internal rotation of right arm,
extended arm with flex wrist +'1("+!ก'(
5+%(#"-&~#0=9>""
0!
1) C1-2
2) C3-4
3) C5-6
4) C8-T1
5) T2-3
10. /""3 30 A 13& %3*/ 5 distal below
knee amputation +#".# stump %'2ก+#".
21!=9>"#0(
"+* (
1) 7 2) 10 3) 15 4) 30 5) 45 ENT
1. %?&"3 36 A ก''5ก 28ก' 2 6"ก&
ก(!
7 ก'5'"!+(28ก ก'8!"(!
T = 37.3 RR = 18 muffled voice , no stridor , erythema
at posterior pharynx film lateral neck 0% ก&&2"
00!!ก
3!
1) Epiglotitis
2) Ludwig angina
3) Tracheobronchitis
4) Paravertebral abscess
5) Retropharyngeal abscess
2. =9>"%?&"3 30 A !"%9 1 =9>"
!& !"&("$ +'1ก%9'&7%
' ก#ก21%" 2 ก( :1&'2!
'
97ก%9+'1!%9ก ก!"&'!' /
" %9"9(+(
(!%9+' 2 left ear drum: normal , right ear drum:
dark blue, retracted ear drum, Weber test: localized to
right, Rinne test: left AC>BC, right BC>AC 2กก
กj
%1
1) Loratadine
2) Pseudoephredine
3) Serratopeptidase 4) Chloramphenical eardrop
5) Myringotomy
3. %'2กŠ‹ก6"&› %9
"!0%9 2
(ก"
ear drum : intact , Weber : no lateralization ,
Renne : Rt BC > AC , Lt AC>BC 2&&2"
1) Acoustic trauma
2) Otosclerosis
3) Meniere
4) Steatosis
5) Otitis media
4. =9>"!8ก 5 9ก%' 2%9# erythematous with
bulging at posterior TM 210%"0!กj
1) Tetracycline
2) Amoxycillin
3) Erythromycin
4) Doxycycline
5) Amoxy-clavulonic
5. !8ก/""3 5 A %"02
"! 5 9ก%'2ก29ก
กA (212ก1
1) Choanal atresia
2) High arch palate
3) Hypertrophy of adenoid
4) Foreign body of nasal cavity
5) Congenital tumor of nasal cavity
6. %?& 25 A !29ก 59ก +'12"9(("$ #+#".
!ก&&2"( 29กก2ก~9&+# !"%"!
8. /" "3 45 A ก!29ก!6" 59ก'! %9
ก
1) CA nasopharynx
2) Chronic otitis media
9. =9>"
2# bullous myringitis ก'3("
0/
กj Macrolide
29ก 6 ! ก(!
7 276 "%"!29ก 3 !
ก+"(' 59กก7 %"02(("ก 2 Dx
1) Atrophic rhinitis
2) Vasomotor rhinitis
3) Chronic irritative rhinitis 4) Rhinitis medicamentosa
5) Severe allergic rhinitis with polypoid change
7. !8ก!"5 9ก
"%8%'2ก29ก6" !"+'ก8(
%" &!(1 Foreign body impact
Eye
1. =9>"!8ก"3 5 A VA 20/40 with pinhole, VA
20/200 6" 20/30 with pinhole 20/100 5ก2
#&&#&&2"~10!
1) Cataract
2) Amblyopia
3) Strabismus
4) Refractive error
5) Color blindness
2. %?&"3 40 A 0(+(" (&%8(
/! !"#1ก' %+((# +(#*!
+("21%8!/! 7 (21!ก~10!
1) Dry eye
2) Cataract
3) Glaucoma
4) Retinitis pigmentosa
5) Loss of accommodation
3. /""3 58 A 28 +! 3 (
'
2
"
PE: Rt eye - ciliary injection, cloudy cornea, shallow
anterior chamber, pupil 5 mm no reactive to
light
Lt eye - deep anterior chamber, lens sclerosis
2 Dx.
1) Acute iridocyclitis
2) Phagomorphic glaucoma
3) Phagolytic glaucoma 4) Acute dry eye
5) intermittent dry eye
4. %?& 55 A ก
% 1 Wk 3 !ก(
"+' Dx chalazion กj !" I&C +' 3 %'
=(+('1 %"1"1%7 +'
21 recurrent ก ก
กj0!%1
3!
5.
6.
7.
8.
9.
10.
1) Local steroid injection
2) I&C with Culture
3) Warm compression with systemic Antibiotics
4) Biopsy and microbial investigation
5) Aspiration and Gram strain, KOH exam and culture
=9>" Glaucoma (acute angle closure glaucoma) 0%
"1ก(
1) Beta blocker
2) Atropine eye drop
3) Pilocapine eye drop
4) Oral glycerol
!8ก"3 3 !"
% % normal cornea กกj
5?0!8ก
1) '
2) ceftriazone im
mature cataract +' glaucoma on top 0%"
1 (Phagomorphic)
!8ก/""3 9 A ก 1 A 2# cobble
bone stone (papillaly) 'ก 2 Vernal
keratoconjunctivitis
%?& 47 A !
j16", %8+
3,ciliary
injection, mild couldy cornea, fixed pupil 5 mm
1) Irridocyclitis
2) Migraine
3) Acute uveitis
4) Acute glaucoma
=9>"%?&"3 50 A ! '2
" 02 1
/ ก( #"' 2#1!" 20/70
cilliary conjuntival injection, Shallow anterior chamber,
Pupil 5 mm fixed 210%กกj=9>""
!+ก
1) Tropical atropine
2) Tropical Alipocane
3) Oral glycerize
4) Oral bata-blocker
5) Oral corticosteroid
11. /""320A 28ก
%'2ก*! contact lens ก2'(7 5 %'ก(
2#
epiphora, mild conjuctival injection, corneal abrasion 2
mm, clear anterior chamber Tx
1) topical ABx
2) pressure patching
3) contact lens C/S
4) evert the upper eyelid
5) lavage the superior cul-de-sac
12. =9>"/
#/%'8ก ก + 9+(!
ก&!2ก?
1) cataract
2) exposure keratitis
3) infrared keratitis
4) UV-keratitis
13. =9>"/""3 29 A ! 5 (
%8
ก& PE: '5!ก 'ก ! 0.5 cm. *(
=&!ก&
2#ก&!2ก=&!ก&0!
1) Entropion
2) Ectropion
3) allergic rhinitis 4) Meibomian gland dysfunction
14. !8ก"3 7 A ก$%"$ 1 A 2 #
Giant papillae 'กj:1 Cubblestone ก&&2"
!ก
3!
1) Trachoma
2) Inclusion Conjunctivitis
3) Hay fever Conjunctivitis
4) Vernal karatoconjunctivitis
5) Epidemic Conjunctivitis
Psychiatry
1. =9>"%?&%3!%&!(" ("9ก( 10& /"2&/0!
ก
3!
1) Thioridazine
2) Risperidone
3) Haloperidol
4) Chlorpromazine
5) Clozapine
2. =9>"!8ก%?& 9 A ("+"ก2ก#(+( ก'+(& !%
+'1!125 ( " 3 !%. ก'%3"
#'!#ก2ก+( Šu"("$ ก'" ='ก&2& " 1) Sibling rivalry
2) Schizophrenia
3) Simple phobia
4) Simple reaction
5) Separation anxiety disorder
3. =9>"%?& "3 45 A ก67 ("ก51
% 0!/("&&2"~167!!
3!
1) !%(" $
2) Šu"(" $
3) ก02("
4) 5+'ก'=&!
5) 97ก(5=&!
4. %?&" "3 25 A ก=(! appendectomy %'
=(! 3 !( (
13&%3
"/
& =9>"
ก67 (#9! % % (%'
%8
"3ก ก
2 wk 2
(ก"ก& 2&&2"~1
1) Normal grief reaction
2) Delirium
3) Brief psychosis
4) Adjustment disorder with depress mood
5) MDD with psychotic feature
5. /""3 24 A underlying schizophrenia /("%'
5! ก=
ก! ก'&ก'
j1
ก1+ก# ' 20 ก("#9! !&
!& =3!'3ก=3! u10(( 5 (ก&( 2&&2"
~1
1) Delirium
2) Akathisia
3) Acute Stress disorder
4) Relapsed schizophrenia
5) Brief psychotic disorder
6. /""3 22 A /
#*3ก 52#( ER
2ก#(=9>" """9ก( '* 11 "" ก
( !ก'+ก' !& *((ก$ :1
2#(=9>"
'กj:1ก 11 "" (("
7.
8.
9.
10.
11.
-& "9( (& (*25+ก 3 "(~"0 5 ! &!((21='2ก0!
1) ก?/
2) 0ก1(
3)  4) 5) +t
0!(0/(&
ก&!70 REM Sleep
1) Dream
2) Penile erection in male
3) Decrease respiratory rate
4) Change in body temperature
5) Near-total paralysis in skeletal muscle
=9>"%?&""3 18 A &กก'5 %กก&
"(ก #""2
"%ก%'2กก&
% (กก&"1"+'1กก5'ก""(%ก +(
#(5%ก"90( ก:Œ.ก& 210%กกj"(
1) Fluoxetine
2) Paroxetine
3) Lithium
4) Imipramine
5) Amitryptylline
/" 40 A !%'125 admit !"'!ก0
ก1#1% :1กj'!%"3!+' &
กก"9((&
ก1ก1" %8215" BP 150/110 HR 80 20%
กกj
1) IM Haloperidol
2) IV Diazepam
3) IM Clopixel adephine
4) IM Clopomazine
5) IM Thiamine
/" 50 A %'+#".+2((181!&5!
=9>"&7 2ก=9>"B&-(/+'1ก(+#".(
ก( '
"(2
#. =9>""9(0ก(
("1"10!
1) Denial
2) Despair
3) Depression
4) Bargaining
5) Anger
/""3 40 A &&2" Schizophrenia กj!""ก!
7 1 !%. =( 97ก02 2# PR = 120/ min,
others: WNL, EKG: sinus tachycardia ก0=9>""
='2ก"00!(
12.
13.
14.
15.
16.
17.
1) Haloperidol
2) Thioridazine
3) Fluphenazine
4) Perphenazine
=9>" Schizophrenia !" Haloperidol 20 mg/d,
Trihexyphenidyl 6 mg/d ก%9+(!
7 +(=9>"("ก
ก&"( #1
กก1ก1" =3!'3ก=3! (21
5"((
1) '!" Haloperidol
2) '
" Haloperidol †††..
3) %"3!"%!+'5 Psychotherapy
4) '
" 2ก"ก&"
!+ long acting
%?&"ก' ก+ &!/ (
-& %
5%ก'! 3 A 20%ก&&2"
1) Schizophrenia
2) Bipolar disorder
3) Anxiety disorder
4) Depressive disorder
/""3 18 A ก'ก
"ก #1ก'+'1
" กก2ก193ก#1
ก'ก&!%3 " /&!*7&
(!
20%กกj
1) Buspirone
2) Imipramine
3) Chlorpromazine
4) Clomipramine
=9>"%?& 35 yr !"02 28%ก %"02(ก ก'
" 2 ! ก'ก %%0%5+15 +'0%
"1
1) Midazolam
2) Lorazepam
3) Clonazepam
4) Temazepam
5) CDZ
/""3 25 A ก&%' 2 A SI กก".125 6 !
ก(&!( HIV '"2=' #=' negative 3
(/='
%ก 3 !ก(!"&
"ก(
ก". 2&2& " DSM IV
1) Conversion disorder
2) Chronic schizophrenia
3) Schizotypal personality disorder
4) Delusion disorder; somatic type
=9>" emphysema 1"13!" BP !
, conscious !
+((
#9!3"ก?& % "
"
1) withdraw
2) develop dementia
3) develop personality disorder
18. %'%3ก:.3& %3*/ #(=9>"
ก PTSD
*( ก0!(0/(ก PTSD
1) 2!25%3ก:.(!'" 2) Šu"
3) 1%ก'
"*".
19. ก'" panic, (
" !2
20%ก
&&2"
1) Panic attack
2) Acute stress disorder
20. !8ก
%3!%&!/+ก'# (02
" Rx?
1) Fluoxetine
2) Imipramine
3) Haloperidol
4) Thiopramine
5) Methylphenidate
21. =9%?&%""3 65 A %'' 67 (("ก&1 (
%' !กกj!""1
22. !8ก/" 9 A " .3 "%(("! 1ก!
'1
5 IQ test ! 109 1+ก( 79 ก
" 80 ก
5: 97 *!8ก1
1) Dyslexia
2) Dyscalculia
3) Mental retardation 4) Attention deficit disorder
5) Autism
Forensic
1. ##*. '!ก'
'" ก!2 +8 (
+8 21:1"1'ก"
1) 2 hr
2) 2-4 hr
3) 4-6 hr
4) 6-8 hr
5) 8-10 hr
2. 2##"!
tก/5+'1
"9! $ "$ =(
##"/5
%'!'!+! +'1
'!ก0/ก'
ก1!9ก Hyoid bone +ก36" (&!("2ก
%30!
1) Mothering
2) Complete hanging
3) Incomplete hanging
4) Ligature strangulation
5) Manual strangulation
3. =9>"/"ก-3ก&2"3 57 A %"8
%#& ก+(%ก %"02(ก ! 7กj+#".ก(0%
#.
=9>"*7
ER 5
EKG (
=&!ก& (=9>"
"/
& 0 20 %'
5( =9> "(t›%'2กก/("/
&ก9/ #8
+' +#".
ก/9# +(2ก=9>"*&'
+'1?&(&!020%3ก" 215#5#&-
'"
(210%ก&jž%3ก"("(
1) Acute poisoning
2) Rupture aneurysm
3) Acute heart failure
4) Cardiopulmonary failure
5) Coronary heart disease
4. =9"*9ก"&!"›
0% 3 ! '5 1 ! /9#
severe brain laceration, fracture base of skull ก13Šu
0 +'1 rupture trachea 21
"0/9%ก"
"(
1) severe brain laceration with gun short wound
,fracture base of skull
2) *9ก"& †..(~j"$)
3) *9ก"& +'1†..(%3" $)
4) severe brain laceration with fracture base of skull
with tracheal rupture
5. %?&"3 26 A *9ก(ก15/5 21#&92."(0%9(
%?&=9*9กก15/52&
1) # sperm 0/('!
2) # sperm & acid phosphatase
3) #!+='tก/5 (ก" +='
vagina +'1#
sperm
4) # sperm 0/(ก
Choice 2ก
ก*%7
1) #32&
vagina
2) #32&+'1532&
vagina %ก ก
3) #("!+='(ก" vagina
4) #&+'ก'"9(0 vagina ก %ก
6. *5ก
!
"ก13
#ก' #ก
(*3#"!%(
1) (!'"
2) ! 'กก13
3) ! ž ก13
7. =9>"%?&!3& %3*ก9 */ 2ก
'!ก/(
'! 2# inevitable abortion 21
"0/9
!+='("(
1) !!282+'9ก
8. /""3 24 A "
"/
&2ก amphetamine ก20!
/("""%!
1) Blood
2) Urine
3) Stomach content
4) Kidney
5) Liver
9. ก#&92.ก'กj:.3' !"0/ก1 %'ก
j1 #( ก1!9กก' 7ก*7/&1
1) Caucasian
2) Mongolian
3) Nigro
10. =9%?&"3 32 A GA 20 wk 13&%3 (#
vaginal bleeding +'1+ #"' 7 ก'
#กt› 20 '%8(
1) !282+
2) "%2+
3) #"'กก( 20 4) #"' 7 #กt› 20 5) "2
'!ก *(กj"*7/
&
Ethics, Preventive & community medicine
1. %?& ! 45 A ก23~#125A0 ก
%'ก1ก3~#*% *21!t
1) CXR
2) Mammogram
3) Fasting blood sugar
4) Blood cholesterol
5) CBC
2. 0%=9>"&กŸ+%(%7 #(=9>"
Nosocomial
infection 20% ก0!(
ˆก!"&-0
!!!
3!
1) '
"'2=9>"
2) '
"'2=9>"
3) *9#3ก 6 / 4) '3กก(-%'==9>"
5) 0(%ก %กก3ก 2=9>"
3. #ก 2000 TB 200 5 CXR #
=&!ก& 150 ( TB CXR =&!ก& 30 CXR =&!ก& ก TB (0!
1) 3
2) 7
3) 15
4) 27
5) 9'(#
"#
4. ก
"%?&"3 19 A &!5"(2%!
!
"/
&+' u223""9(ก#
/""3 20 A
+'1/""3 30 A 3:9125/#!8กก
"%?&
!ก'(!"'5!ก
" (! +#".
&&2"(*35 ( 25กกj!"ก
=(! "ก(0=9
52!&020ก"&"
0%=(!
1) &!
2) #
/"
3) /"
4) =9>"
5) 3:9125/
5. %ก(=95"ก #"'/3/ #(
=9>" 2&/2ก"#&!25ก (21
+2!ก#
'!u?%"(
1) /( (กj
#"
2) 52ž #2ก3
#&!0'!
3) #‘0% #.*กj 2&/!!
7
4) 0%9+'1(ก
" กu?%0%1/กก'3(
"
5) (ก0/3/ ='ก!กB%"0%'3
6. ก! RCT ='ก5 chemo กก=(!
ก1ก3(+"ก=9>" 2 ก'3( # ?
1) #&........
2) '!........
3) #&520ก%+ก(
4) ก12"+
='(ก7กj($ก
7. +#".-&"0%=9>"tuก
"ก*31.+'1
ก ='!
='
" #0%=9> "!&02( ก
!"02 +#".5 2&"-0!
1) Beneficence
2) Autonomy
3) Confidentiality
8. ก2(ก"125A #( #ก%! 2.000 =' xray =&!ก& 80 CA 50 +(
#ก
1,920 =' xray ก&+( CA 150 *(0
x-ray ก& 21
ก CA ก
% (25 choice (!)
(21+
CA
( CA
X-ray =&!ก& 50
30
80
X-ray ก&
150 1770
1920
200
1800
2000
9. !"3 16 A ("0% LP '9ก *(+#".5
"(
10. 7กj"'!!0!8ก 0/ cuff =90%?(0ก!
! =&!#'!ก&!2ก1
1) Bias
2) Chance
3) Confounder
4) Contamination
5) Co-intervention
11. !8ก/""3 2 ! 67 2(ก"""%3
ก 25 LP +(+("3 16 A("&"#1ก'
'9ก28 +-&"+' +#".5"(!+ก
1) ( #"'
2) 0%+(68B&-กกj
3) 0% ATB !"(21%'
4) 21%'
#1~1(!(
5) 0%&!68"&"
12. ก5 ก(&3~#/3/0/1ก
!3
1) social empowerment